1. National Forum Production Programmes May 2013
Accelerated
Releasing Time to Care
National Forum
Production Programmes
May 2013

2. Background
ADHB commenced Releasing Time to Care is 2009 with 33 Wards now underway
ADHB investigated alternative delivery options for RTC
An accelerated approach was chosen with a pilot ward commencing in July 2012
Support resource was allocated to work with the team to deliver on a module a month until completion

3. Accelerated Programme Approach
7-9 Months
Ongoing
Shift Handover
Meals
Patient Observations
Patient Hygiene
Medicines
Admissions and Planned D/C
Ward Rounds
Nursing Procedures
Nursing Procedures
Nursing Procedures
Process Modules
Knowing How We are Doing
Well Organised Ward
Patient Status at a Glance
Foundation Modules

4. Module Implementation – Monthly timeline
Preparation
Week 1
Launch
Week 2 & 3
Develop
Week 4
Implement
Follow Up
Agree team and confirm roster
Collect Data
Learn from other Wards
Generate excitement
Patient Interviews
Staff Interviews
Process follows
Review data
Go-see
Identify opportunities
Define new process
Agree implementation timeframe and communications plan
Develop Process Flowchart
Develop SOPs
Develop Templates
Engage other stakeholders
Order new equipment
Plan facilities improvements
Staff Education
Go Live with process improvements
New equipment
Facilities improvements
Audits
Celebrate success

5. Key Principles
Steal with pride - capitalise on the work done and improvements made by other wards
Manage scope – focus on specific areas of improvement
Communication, Communication, Communication – use the Daily Ward Meetings as a key tool to ensure everyone knows what is happening, why and when
Quick fire – keep energy, focus and motivation high by maintaining momentum
Share the load – utilise as many of the ward team as possible to implement change
Build for the future – develop resources to be utilised by other wards

6. Results - Overall Reduction in Pressure Injuries = 0 in 6 months
Direct Care Time
= 54%
(38% Improvement)
7 Process Modules delivered
Reduction in
Length of Stay
>0.8 days
Patient Satisfaction
= 91 %
3 Foundation Modules extended
Sustained
Smoking Cessation >95%
Staff Satisfaction
= 84 %
Sustained
Acute Patient Flow >95%
“It really has increased the amount of time we can spend with the patients”
– Staff Member

7. Knowing How We are Doing
Revisited the Ward Vision with input from the Multidisciplinary team
Implemented Daily Ward Meetings
Maintained communications boards and safety crosses
“The atmosphere on the ward has changed.  You can feel it as you walk in, things are calm and organised.”
- Staff Member

8. Well Organised Ward 4 bedded Rooms Equipment Room Staff Base
Whanau Room
Education Hub
Ward Meeting Room
Sluice Room
“I can find things! Everything has its place.”
– Staff member

9. Patient Status at a Glance
Electronic Whiteboards updated with required flags
New wide screens to improve usability
Patient Bedcards implemented
Staff Status at a Glance Board
Rapid Rounds maintained

10. Shift Handover ISOBAR Bedside Handover Patient involvement
Improved information transfer
Safety checks
Significant impact on direct care time
“When the nurses change shifts they introduce who they are and that they’re our nurse”
- Patient

11. Meals Improved focus on patient preparation
Implementation of a meal preparation bell
Nurses assisting patients to complete meal cards – ensuring sufficient food is ordered and less meal call backs are required
Improved use of assist flags for those patients needing any assistance at meal times
Improved timing of meal delivery

12. Patient Observations
Improved observation trolley set up to reduce waste looking for additional equipment
Relocation of observation equipment to point of use (i.e. within 4-bedded rooms and outside single bedded rooms)
Refreshed patient observation standards including education
“The ward seems calm and everyone knows what they are doing.”
- Patient

13. Patient Hygiene Hygiene packs
Where am I posters for Commode and Wash Bowl Trolley
Agreed standards on patient hygiene requirements
“The staff are fantastic! I would give them 100%. They work so hard and every single one of them took time for a chat and you were never rushed.”
- Patient

14. Medicines New layout and refurbishment of the medication room
Improved access to controlled drugs cabinet
Reduce stock levels
Improved education for patients

15. Admissions and Planned Discharges
New patient welcome pack including
Ward information Booklet
Ward and hospital maps
What to expect information
Transition lounge brochure
Hospital Resources
Staff Admission checklist
Agreement that discharge summaries are written 24 hours before discharge to allow for review by the consultant and better discussion with the patient

16. Ward Rounds Agreed sequence and flow
Portable laptop to be used during Ward Rounds
Patient nurse to attend Ward Rounds
Ward Rounds information sheet for patients in the Welcome Pack including space to capture questions for the Medical Team
Improved signage and awareness around which teams are rounding and when
Consultant to sit down during Ward Rounds to enable better engagement with the patient and their support person(s)
Junior doctor to read back plan to ensure clarity and correctness

17. Conclusion
Ward 72 has benefited from the combined impact of the Accelerated Releasing Time to Care programme, Rapid Rounds and daily ward meetings
The ward is now better organised with clearly defined processes.
The improvements have resulted in a calmer work environment that provides a better patient experience
The fast pace of implementation along with the significant team involvement has resulted in a continuous stream of improvements on the ward keeping team motivation and engagement high
“Getting better every day! Great place to work!”
- Staff member

18. Do you have any questions?
For future questions please contact
Abbi Harwood-Tobin or )
Marie Mata or )
Sarah Wilson )
“It means nurses can identify REAL problems… and fix them!”
- Staff Member